LABORATORY AND DIAGNOSTIC TESTS
anemia
LABORATORY EXAMS
• CBC (Complete Blood Count)
• Stool
• Urinalysis
• Sputum
• FBS (Fasting Blood Sugar)
CBC (Complete Blood Count)
- a common series of blood tests that can be
done on a fairly small sample of blood
taken from a vein.
- a CBC test usually includes: WBC count,
RBC count, hematocrit count, hemoglobin
count, platelet count, and a blood smear
Purpose:
• to identify persons who may have an
infection
• to diagnose anemia
• to identify acute and chronic illness,
bleeding tendencies, and white blood cell
disorders such as leukemia
• to monitor treatment for anemia and other
blood diseases
• to determine the effects of chemotherapy
and radiation therapy on blood cell
production
How is the patient prepared?
 no special preparation is needed prior to
this procedure
 tell the patient to wear a short-sleeve shirt
to make things easier for the technician
who will be drawing blood
Normal values:
• Red blood cell (RBC)
– Male: 4.5 - 5.3 million/mm3
– Female: 4.1 - 5.1 million/mm3
Increased: Primary and secondary polycythemia
Decreased: Abnormal loss and destruction of
erythrocytes
• Hemogloboin (HgB)
– M: 13.8 - 18 g/dL
– F: 12 - 16 g/dL
Increased: Polycythemia
Decreased: Blood loss; hemolytic anemia; bone
marrow suppression; sickle cell anemia
• Hematocrit (Hct)
– M: 37 - 49 %
– F: 36 - 46 %
Increased: Polycythemia; dehydration; burns
Decreased: Blood loss; overhydration; dietary
deficiency’ anemia
• Red blood cell indices (RBC indices)
– M: 78 - 100 um3
– F: 78 - 102 um3
Increased: Liver disease; alcoholism; pernicious
Decreased: Iron deficiency anemia; lead poisoning
• White blood cell (WBC)
– 4,500 - 11,000/mm3
Increased: Leukocytosis; infection
Decreased: Leukopenia; autoimmune disease
• Platelet count
– 150,000 - 350,000mm3
Increased: Malignant tumors; polycythemia vera
Decreased: Idiopathic; thrombocytopenic purpura;
viral infections; AIDS; systemic lupus
erythematosus; chemotherapy drugs; some
types of anemias
Stool
- one wherein fecal matter is collected for
analysis to diagnose or be able to provide
information about the presence or absence
of a medical condition .
Purpose:
• provides valuable information as to what is
wrong when the patient has a problem in
the stomach, intestines, or part of the
gastrointestinal system
• to determine the presence of occult
(hidden) blood
• most common reason to collect stool is to
determine whether a type of bacteria or
parasite may be infecting the intestine
• stools are also analyzed for the substances
they contain, like fat
• allergy or inflammation in the body, such
as part of the evaluation of milk protein
allergy in infants
• digestive problems, such as the
malabsorption of certain sugars, fats, or
nutrients
• bleeding inside of the gastrointestinal tract
What are my responsibilities as a nurse?
 explain clearly to the patient the purpose
of the specimen collection and the
procedure for obtaining the specimen
 note the relevant information on the
laboratory requisition slip, for example,
medications the client is taking that may
affect the results
 provide client comfort, privacy, and safety
 use the correct procedure for obtaining a
specimen or ensure that the client or staff
follows the correct procedure; and be sure
to perform aseptic technique
 transport the specimen to the laboratory
promptly. Fresh specimens provide more
accurate results
 report abnormal laboratory findings to the
health care provider in a timely manner
consistent with the severity of the
abnormal results

How is the patient prepared?
 let the patient defecate in a clean bedpan
or bedside commode
 for women, if possible do not contaminate
the specimen with urine or menstrual
discharge
 void before the specimen collection
 do not place toilet tissue in the bedpan
after defecation
 tell the patient to notify the nurse for
specimens that need to be sent to the
laboratory immediately
Normal findings:
A normal result means only normal or
"friendly" bacteria were seen on the stained slide.
Everyone has friendly bacteria in their intestines.
Abnormal findings:
There is presence of other microorganisms,
which indicates an infection.
Urinalysis
- the collection of urine specimen to run a
number of tests; and is used to check for
abnormalities in the urine which could
otherwise indicate the presence of a
disease.
Purpose:
• general health screening to detect
renal and metabolic diseases
• diagnosis of diseases or disorders of
the kidneys or urinary tract
• monitoring of patients with diabetes
Methods of obtaining specimen
• Midstream clean-catch urine
– area surrounding the opening of the
urethra is cleansed and rinsed well
– a small amount of urine should then
be allowed to fall into the toilet and
the rest should be collected
midstream in a clean container
• Timed urine specimen
– specimen is generally either
refrigerated or contain a
preservative to prevent bacterial
growth or decomposition of urine
components
– each voiding of urine is collected in
a small, clean container and then
emptied immediately into the large
refrigerated bottle
• Catheterized urine specimen
– a lubricated catheter (thin rubber
tube) is inserted through the
urethra into the bladder
– avoids contamination from the
urethra or external genitalia
– uses sterile needle to obtain urine
Types of urinalysis
• Dipstick tests
– involve placing papers that contain
small pads of chemicals into the
urine sample. These papers change
color when exposed to various
substances in the urine
• Tablet tests
– tablets are moistened with urine
and react in response to various
substances
• Chemical tests
– include checking the pH level
(acidity/alkalinity) and the specific
gravity (concentration) of the urine
• Microscopic tests
– include checking for bacteria and
other microorganisms
How is the patient prepared?
 drinking a glass of water 15-20 minutes
before the test is helpful if there is no urge
to urinate
 specimen must be free of fecal
contamination, so urine must be kept
separate from feces
 women should discard the toilet tissue in
the toilet or in a waste bag rather in the
bedpan because tissue in the specimen
makes laboratory analysis more difficult
 the lid tightly on the container to prevent
spillage of the urine and contamination of
other objects
 patients who are seriously ill, physically
incapacitated, or disoriented may need to
use a bedpan or urinal in bed
 urinalysis should be performed within 15
minutes of collecting the urine sample. If
that is not possible, the urine should be
refrigerated
What are my responsibilities as a nurse?
 make sure that the specimen label and the
laboratory requisition carry the correct
information
 attach the labels securely to the specimen
 UAP (unlicensed assistive personnel) may
be assigned to collect a routine urine
specimen. Provide the UAP with clear
directions on how to instruct the client to
collect his or her own urine specimen or
how to correctly collect the specimen for
the client who may need to use a bedpan
or a urinal
Some normal urine constituents excreted (in • to identify the best antibiotic to treat the
g/24 hours): infection (sensitivity testing)
• for cytology to identify origin, structure,
Urea 25-30 function, and pathology of cells
Uric acid 0.6-0.7 • to monitor the treatment of the infection
Creatinine 1.0-1.2 • to assess the effectiveness of therapy
Hippuric acid 0.7 Sputum is a thick fluid produced in the lungs and
Ammonia 0.7 in the adjacent airways.
Amino acids 3
Sodium 1-5 (NaCl 15.0) What are my responsibilities as a nurse?
Potassium 2-4  offer mouth care so that the specimen will
Calcium 0.2-0.3 not be contaminated with microorganisms
Magnesium 0.1 from the mouth
Chloride 7  ask the patient to breathe deeply and
Phosphate 1.7-2.5 cough up 1 to 2 tablespoons, or 15 to 30
Sulfate 1.8-2.5 mL (4 to 8 fluid drams)
 wear gloves and personal protective
equipment to avoid direct contact with the
sputum
 ask the patient to expectorate the sputum
into the specimen container; and make
sure it doesn’t contact the outside. If it
does, wash it with a disinfectant
Normal values expected for a fresh, clean-  following the collection, offer mouthwash to
catch, mid-stream collection remove any unpleasant taste
 label and transport the specimen to the lab
Test Reference range and ensure it is labelled properly with the
Color Straw - Dark yellow correct requisition
Appearance Clear - Hazy  document the collection of sputum on the
Specific Gravity 1.003-1.029 patient’s chart
pH 4.5-7.8
Protein Negative How is the patient prepared?
Glucose Negative  usually, the sputum sample is collected
Ketones Negative early in the morning before the patient eats
Bilirubin Negative or drinks anything
Occult blood Negative  specimen for culture should be collected
Leukocyte Esterase Negative before antibiotics are begun
Nitrite Negative  if the patient wears dentures, he will have
Urobilinogen 0.1-1.0 EU/dL to remove them; and then have him rinsed
WBCs 0-4/hpf his mouth with water before coughing
RBCs male: 0-3/hpf begins
female: 0-5/hpf  through a deep cough, the patient must
Casts 0-4/lpf cough up sputum from within the chest
Bacteria Negative  taking deep breaths and lowering the head
helps bring up the sputum
Normal result:  sputum must not be held in the mouth but
No growth of bacteria, indicating absence immediately spat into a sterile container
of infection.
Abnormal result: Normal results:
If bacteria is found, indicative of a urinary Sputum from a healthy person would have
tract infection. Contamination of the specimen no growth on culture. A mixture of
from hair, external genitalia, or the rectum may microorganisms, however, normally found in a
cause a false-positive result. person's mouth and saliva often contaminates the
culture. If these microorganisms grow in the
Sputum Culture culture, they may be reported as normal flora
-a test to detect and identify bacteria or fungi that contamination.
infect the lungs or breathing passages Abnormal results:
Purpose: The presence of bacteria and white blood
• to help identify microorganisms that are cells on the Gram stain and the isolation of a
causing respiratory disease or infection. microorganism from culture, other than normal
flora contamination, is evidence of a lower
respiratory tract infection.
FBS (Fasting Blood Sugar)
- measures blood glucose after you have not
eaten for at least 8 hours. It often is the
first test done to check for diabetes
Purpose:
• to determine for abnormally low or high
blood sugar levels; and to determine what
causes these
• screening for DM and gestational diabetes
• for blood glucose monitoring
• to monitor treatment of such cases or
condition
How is the patient prepared?
 the patient should not eat or drink anything
other than water for at least 8 hours before
the blood sample is taken
 if you have diabetes, you may be asked to
wait until you have had your blood tested
before taking your morning dose of insulin
or diabetes medication
the heart, lungs, airways, blood vessels and
the bones of the spine and the chest.
Purpose:
• used to help diagnose lung conditions such
as pneumonia, heart problems, COPD
(chronic obstructive pulmonary disease),
lung cancer, and other medical conditions
• to help monitor treatment for the above-
mentioned conditions
• to see if a tube, catheter, or other medical
device has been placed in the proper
position in a lung, the heart, blood vessels
of the chest, or the stomach
• to see foreign objects such as coins or
other small pieces of metal that have
entered the esophagus, the airway, and the
lungs
What are my responsibilities as a nurse?
 to assist the x-ray technologist in obtaining
the film
 to ensure that tubes and lines are not
disturbed during the process
 to look at the x-ray and note appropriate
line placement
 to be able to recognize any abnormalities
or symptoms with the help of the
radiologist

How is the patient prepared?

 a woman must tell the physician if there is
any possibility that she might be pregnant
Normal Values  the patient may be asked to remove some
Test Range or all clothings and to wear a gown during
fasting plasma glucose 55–109 mg/dL the exam
OGTT at two hours less than 140 mg/dL  women will be asked to tie their hair up in a
glycated hemoglobin 3%–6% ponytail
fructosamine 1.6–2.7 mmol/L for  remove all jewelries, eye glasses, hair
adults (5% lower for accessories, and any metal objects that
gestational diabetes children) might interfere with the x-ray images
screening less than 140 mg/dL  talk to your doctor about any concerns you
cerebrospinal glucose have regarding the need for the test, its
serous fluid glucose 40–80 mg/dL risks, how it will be done, or what the
synovial fluid glucose equal to plasma glucose results mean
within 10 mg/dL of the
urine glucose (random plasma glucose Normal findings:
semiquantitative) • Lungs
negative – lungs look normal in size and shape,
and the lung tissue looks normal
– no growths or other masses can be
DIAGNOSTIC EXAMS seen within
• Chest X-ray – pleural spaces also look normal, no
• Ultrasound accumulations
• CT Scan (Computed Tomography) • Heart
• MRI (Magnetic Resonance Imaging) – normal in size, shape, and heart
tissue looks normal
Chest X-ray – blood vessels leading to and from
the heart also are normal in size,
- the most commonly performed diagnostic
shape, and appearance
x-ray examination which makes images of
• Diapragm
– looks normal in shape
 – properly located
• Others:
– no abnormal collection of fluid or air
is seen
– no foreign objects present
– all tubes, catheters, or other
medical devices are in their correct
positions in the chest
Abnormal findings:
• Heart
– enlarged heart which could be
caused by heart damage or heart
valve disease
– fluid around the heart is seen
– a problem of the blood vessels is
seen
• enlarged aorta
• aneurysm
• artherosclerosis
• Others:
– fluid is seen; or air is seen in the
spaces of a lung
– an infection, such as pneumonia or
tuberculosis, is present
– problems such as a tumor, injury, or
a condition such as edema from
heart failure may be seen
– fractures are seen in the ribcage,
collarbone, shoulder, or spine
– enlargement of lymph nodes
– foreign object is present
– a tube, catheter, or other medical
device looks like it has moved out of
the correct position
Ultrasound
- also called ultrasound scanning or
sonography, involves exposing part of the
body to high-frequency sound waves to
produce pictures of the inside of the body.
It does not use ionizing radiation as used in
x-rays
Purpose:
• used to detect changes in appearance of
organs, tissues, and vessels or detect
abnormal masses, such as tumors
• to show the structure and movement of the
body’s internal organs, as well as blood
flowing through the blood vessels
• performed to evaluate and diagnose
conditions in the: kidneys, liver,
gallbladder, pancreas, spleen, abdominal
aorta, ovary, uterus and other reproductive
organs.
• done to provide guidance in biopsies
What are my responsibilities as a nurse?
 to explain the procedure well to the patient
 to assist the radiologist in any way
possible, especially on and with the
procedure itself
 be sure to know about the patient’s status
regarding previous tests done so as to
provide safety
How is the patient prepared?
 the patient should wear comfortable, loose-
fitting clothes
 he should tell the doctor if he has had any
tests done within the past two days on the
part of his body to be examined
 for a study of the liver, gallbladder, spleen,
and pancreas, you may be asked to eat a
fat-free meal on the evening before the
test and then to avoid eating for eight to 12
hours before the test
 for ultrasound of the kidneys, you may be
asked to drink four to six glasses of liquid
about an hour before the test to fill your
bladder. You may be asked to avoid eating
for eight to 12 hours before the test to
avoid gas buildup in the intestines
 for ultrasound of the aorta, you may need
to avoid eating for eight to 12 hours before
the test.
CT Scan (Computed Tomography)
- Or CAT scans, are special x-ray tests that
produce cross-sectional images of the body
organs and tissues using x-rays and a
computer.
- completed with the use of a 360-degree x-
ray beam and computer production of
images
Purpose:
• to evaluate and diagnose conditions in the
sinus, brain, body, aorta and chest.
How is the patient prepared?
 pregnant women or those who could
possibly be pregnant should not have a CT
scan unless the diagnostic benefits
outweigh the risks
 if the patient is to have a contrast injection,
he should not have anything to eat or drink
for a few hours before his CT scan because
the injection may cause stomach upset
 no metal may be worn
 what clothing is worn depends on the
nature of the study. A hospital gown may
be used, or just normal street clothes
 sedation is not necessary
Normal results:
• show bone, the densest tissue, as white
areas
 • tissues and fat will show as various shades
of gray
• fluids will be gray or black
• air will also look black
• intravenous, oral, and rectal contrast
appears as white areas
Abnormal results:
• show different characteristics of tissues
within organs
• accumulations of blood or other fluids
where they do not belong may be detected

MRI (Magnetic Resonance Imaging)

-radiology technique that uses magnetism, radio
waves and a computer that enable medical
professionals to see deep within the human body
in a noninvasive way, that is, without entering the
body or breaking the skin.
Purpose:
• similar to a CT scan, but it uses magnetism
instead of x-rays

How is the patient prepared?

 all metallic objects on the body are
removed prior to obtaining a scan
 no special diet, medication or fasting is
required before the examination
 prior to undergoing MRI the patient should
be asked if he has ever had any type of
permanent coloring technique (like
tattooing) applied to any part of the body
 tell the patient to let the doctor or his
health care provider know if he is
claustrophobic (afraid of confined spaces)
 occasionally, patients will be given a
sedative medication to decrease anxiety
and relax the patient during the procedure

Normal results:
Abnormal results:
∗ both are the same with those of CT scan
results